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Textbook
Introduction
1. Cardiovascular system
2. Pulmonary system
3. Neuromuscular system
4. Pediatrics
5. Musculoskeletal system
5.1 Anatomy of musculoskeletal system
5.2 Anatomical terminology and exercise training principles
5.3 Joint mechanics and phases of healing
5.4 Upper extremity anatomy
5.5 Special tests of upper extremity
5.6 Comparing clinical presentation and interventions for upper extremity
5.7 Lower extremity anatomy
5.8 Special tests of lower extremity
5.9 Comparing clinical presentation and interventions for lower extremity
5.10 Spine and pelvis anatomy
5.11 Special tests of the spine, pelvis, and temporomandibular joint
5.11.1 Cervical spine tests
5.11.2 Thoracolumbar, sacroiliac, and TMJ tests
5.12 Comparing clinical presentation and interventions for the spine, pelvis, and temporomandibular joint
5.13 Other musculoskeletal conditions
5.14 Gait
5.15 Prosthetics
5.16 Orthotics
5.17 Medications, imaging, and fractures
5.18 Surgical protocols
6. Other systems
7. Non-systems
Wrapping up
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5.11.2 Thoracolumbar, sacroiliac, and TMJ tests
Achievable NPTE-PTA
5. Musculoskeletal system
5.11. Special tests of the spine, pelvis, and temporomandibular joint
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Thoracolumbar, sacroiliac, and TMJ tests

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These special tests cover the thoracic and lumbar spine, the sacroiliac joint, and the temporomandibular joint.

PTA role: within the established plan of care, the PTA performs these tests to collect data. Record positive findings and report changes to the supervising PT; don’t use them to diagnose, re-evaluate, or change the plan. Stop testing and notify the PT if symptoms move further down the leg (peripheralize), worsen sharply, or come with red flags such as saddle anesthesia or new bowel/bladder changes. For example, if a slump test reproduces leg symptoms during a treatment activity, stop or modify the activity, document the finding, and report it to the PT.

Thoracic spine scoliosis screening

  • Adams forward bend test:
    • The child bends forward at the waist while keeping their knees straight.
      • Checks for any asymmetry or curvature in the spine.
    • Positive: elevation of the ribs on one side of the spine
Adams forward bend test with trunk asymmetry.
Adams forward bend test
Achievable

Lumbar spine

  • Slump test
    • Tests for neurological dysfunction of the lower extremity
    • Patient sits with knees flexed and the head and neck neutral, then the test progresses one step at a time:
      1. Slump into thoracic and lumbar flexion
      2. Passively flex the head and neck
      3. Passively extend the knee
      4. Passively dorsiflex the ankle
      5. Repeat with the opposite leg
    • The therapist stops at the step where symptoms are reproduced
    • Positive: reproduction of pain, paresthesias, numbness/tingling, or other neurological symptoms. This tests the mobility and sensitivity of the neural tissue, as seen with disc herniation or sciatica; symptoms that ease when neck flexion is released (neck returned to neutral or extension) support a neural source rather than hamstring tightness.
Slump test with cervical flexion and knee extension.
Slump test
Achievable
  • Prone instability test
    • Patient prone with torso supported on the mat, legs off the edge, with both feet supported on the ground. The therapist applies posterior/anterior springing throughout the lumbar spine to identify painful segments. The therapist then instructs the patient to lift the legs off the floor and perform the same posterior/anterior springing
      • Tests the instability of the lumbar spine
      • Positive: pain with springing while the feet rest on the ground that decreases or resolves once the patient actively lifts the legs. This shows the patient can stabilize the segment through muscle activation, consistent with clinical lumbar instability that would respond to stabilization exercise.
Prone instability test with trunk extension and lower-extremity activation.
Prone instability test
Achievable
  • Lumbar spine quadrant test (Kemp’s test)
    • Patient standing
      • The patient stands and is guided by the practitioner to maximally extend their spine, then rotate and laterally flex toward the side of the pain. The practitioner applies a gentle downward pressure
      • Tests the compression of neural structures at the facet and intervertebral foramen
      • Positive: pain or paresthesias in a dermatomal pattern or localized pain if facet dysfunction
Standing lumbar quadrant test with extension, rotation, and side bending toward the painful side
Lumbar quadrant test
Achievable

Lower limb neural tension tests

  • Lower limb tension tests assist with identifying peripheral nerve injury by placing the lower limb in positions that will stress the nerve
  • Prone knee flexion (femoral nerve stretch test)- patient prone; the therapist flexes the knee while extending the hip to test the femoral nerve
    • Positive: pain or paresthesia in the anterior thigh, suggesting L2-L4 nerve root or femoral nerve involvement
Femoral nerve stretch test with prone knee flexion and hip extension.
Femoral nerve stretch test
Achievable
  • Straight leg raise (SLR)- test sciatic and tibial nerve
    • Hip: flexion (neutral rotation)
    • Knee: extension
    • Ankle: dorsiflexion
    • Positive: radiating leg pain or paresthesia below the knee, typically between about 30° and 70° of hip flexion. Adding ankle dorsiflexion that worsens symptoms supports a neural source.
Straight leg raise test with passive hip flexion and knee extension.
Straight leg raise
Achievable

Sacroiliac

  • Long sitting
    • Patient supine with therapist palpating the medial malleolus- therapist observes alignment. The therapist then asks the patient to come to a long sitting position to observe if alignment at the medial malleolus is still present.
      • Tests for a functional leg length difference caused by sacroiliac/innominate dysfunction
    • Positive: leg length changes between supine and long sitting. Long in supine to short in long sitting indicates anterior innominate rotation; short to long indicates posterior innominate rotation (memory aid: long-to-short = anterior).
Supine to long sitting test comparing medial malleoli
Supine long sitting
Achievable
  • Gaenslen’s test
    • Patient supine with one leg hanging off the table edge; the therapist presses the opposite flexed knee toward the chest while pressing down through the hanging leg
      • Provocation test for the sacroiliac joint
    • Positive: reproduction of the patient’s familiar pain

Temporomandibular joint (TMJ)

A bilateral synovial joint with articulation between the mandible and the cranium. The articular disc lies between areas of articulation in which there is no vascularization or neural supply. The disc (collateral) ligaments attach the disc to the condyle, so the disc moves anteriorly and posteriorly with the condyle while being kept from displacing medially or laterally. Movements of the TMJ are a combination of axis rotation and sliding movements. Types of movement are seen below:

  • Elevation (closing):
    • Contraction of the masseter, temporalis, and medial pterygoid muscles raises the mandible.
  • Depression (opening):
    • Relaxation of the elevator muscles and contraction of the lateral pterygoid, digastric, geniohyoid, and mylohyoid muscles lowers the mandible.
  • Protrusion (forward movement):
    • Contraction of the lateral pterygoid muscles moves the mandible forward.
  • Retrusion (backward movement):
    • Contraction of the posterior fibers of the temporalis muscles moves the mandible backward.
  • Lateral deviation (side-to-side movement):
    • Contraction of the lateral pterygoid muscle on one side moves the mandible toward the opposite side.

In TMJ disc displacement with reduction, the displaced disc returns to position as the mouth opens and produces a click; in disc displacement without reduction, the disc stays displaced, the click disappears and mouth opening is limited (closed lock).

Special tests of TMJ

  • TMJ compression
    • Patient sitting or supine; therapist stabilizes the patient’s head with one hand while the other hand pushes the mandible superiorly, causing a compressive load to the TMJ
      • Assess pain in the retrodiscal tissues
    • Positive: pain in the TMJ
Sagittal anatomy of the temporomandibular joint and articular disc
Mandibular joint
Henry Vandyke Carter (1831-1897), Henry Gray (1918) Anatomy of the Human Body
/
Wikimedia Commons
/
Public domain

PTA role in special tests

  • Perform tests only within existing plan of care to collect data, not to diagnose or alter treatment
  • Report positive findings to supervising PT
  • Stop testing/activity if symptoms peripheralize, worsen sharply, or red flags appear (saddle anesthesia, bowel/bladder changes); document and report

Thoracic spine scoliosis screening

  • Adams forward bend test: child bends forward, knees straight
  • Positive: rib elevation/asymmetry on one side indicates spinal curvature

Lumbar spine special tests

  • Slump test: sequential slump, neck flexion, knee extension, ankle dorsiflexion; positive = reproduction of neural symptoms (pain, paresthesia); symptom relief with neck extension supports a neural (not hamstring) origin
  • Prone instability test: PA springing with feet on floor vs. legs lifted; positive = pain resolves with active leg lift, indicating muscular stabilization capacity (lumbar instability)
  • Lumbar quadrant/Kemp’s test: standing extension + rotation + lateral flexion toward painful side with overpressure; positive = dermatomal pain/paresthesia (nerve compression) or localized pain (facet dysfunction)

Lower limb neural tension tests

  • Prone knee flexion (femoral nerve stretch test): prone, knee flexion + hip extension; positive = anterior thigh pain/paresthesia (L2-L4/femoral nerve)
  • Straight leg raise (SLR): hip flexion, knee extension, ankle dorsiflexion; positive = radiating pain below knee typically between 30°-70° hip flexion; worsening with dorsiflexion supports neural source (sciatic/tibial nerve)

Sacroiliac joint test

  • Supine-to-long-sitting test: compare medial malleoli alignment supine vs. long sitting
  • Positive = leg length change: long→short indicates anterior innominate rotation; short→long indicates posterior rotation (mnemonic: long-to-short = anterior)

TMJ anatomy and movements

  • Bilateral synovial joint (mandible-cranium) with avascular, non-innervated articular disc stabilized by collateral ligaments
  • Movements: elevation (masseter, temporalis, medial pterygoid), depression (lateral pterygoid, digastric, geniohyoid, mylohyoid), protrusion (lateral pterygoid), retrusion (posterior temporalis), lateral deviation (unilateral lateral pterygoid moves mandible to opposite side)

TMJ special test

  • TMJ compression: stabilize head, push mandible superiorly to compress joint/retrodiscal tissue
  • Positive = pain in TMJ

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Next  | 5.12 Comparing clinical presentation and interventions for the spine, pelvis, and temporomandibular joint
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Thoracolumbar, sacroiliac, and TMJ tests

These special tests cover the thoracic and lumbar spine, the sacroiliac joint, and the temporomandibular joint.

PTA role: within the established plan of care, the PTA performs these tests to collect data. Record positive findings and report changes to the supervising PT; don’t use them to diagnose, re-evaluate, or change the plan. Stop testing and notify the PT if symptoms move further down the leg (peripheralize), worsen sharply, or come with red flags such as saddle anesthesia or new bowel/bladder changes. For example, if a slump test reproduces leg symptoms during a treatment activity, stop or modify the activity, document the finding, and report it to the PT.

Thoracic spine scoliosis screening

  • Adams forward bend test:
    • The child bends forward at the waist while keeping their knees straight.
      • Checks for any asymmetry or curvature in the spine.
    • Positive: elevation of the ribs on one side of the spine

Lumbar spine

  • Slump test
    • Tests for neurological dysfunction of the lower extremity
    • Patient sits with knees flexed and the head and neck neutral, then the test progresses one step at a time:
      1. Slump into thoracic and lumbar flexion
      2. Passively flex the head and neck
      3. Passively extend the knee
      4. Passively dorsiflex the ankle
      5. Repeat with the opposite leg
    • The therapist stops at the step where symptoms are reproduced
    • Positive: reproduction of pain, paresthesias, numbness/tingling, or other neurological symptoms. This tests the mobility and sensitivity of the neural tissue, as seen with disc herniation or sciatica; symptoms that ease when neck flexion is released (neck returned to neutral or extension) support a neural source rather than hamstring tightness.
  • Prone instability test
    • Patient prone with torso supported on the mat, legs off the edge, with both feet supported on the ground. The therapist applies posterior/anterior springing throughout the lumbar spine to identify painful segments. The therapist then instructs the patient to lift the legs off the floor and perform the same posterior/anterior springing
      • Tests the instability of the lumbar spine
      • Positive: pain with springing while the feet rest on the ground that decreases or resolves once the patient actively lifts the legs. This shows the patient can stabilize the segment through muscle activation, consistent with clinical lumbar instability that would respond to stabilization exercise.
  • Lumbar spine quadrant test (Kemp’s test)
    • Patient standing
      • The patient stands and is guided by the practitioner to maximally extend their spine, then rotate and laterally flex toward the side of the pain. The practitioner applies a gentle downward pressure
      • Tests the compression of neural structures at the facet and intervertebral foramen
      • Positive: pain or paresthesias in a dermatomal pattern or localized pain if facet dysfunction

Lower limb neural tension tests

  • Lower limb tension tests assist with identifying peripheral nerve injury by placing the lower limb in positions that will stress the nerve
  • Prone knee flexion (femoral nerve stretch test)- patient prone; the therapist flexes the knee while extending the hip to test the femoral nerve
    • Positive: pain or paresthesia in the anterior thigh, suggesting L2-L4 nerve root or femoral nerve involvement
  • Straight leg raise (SLR)- test sciatic and tibial nerve
    • Hip: flexion (neutral rotation)
    • Knee: extension
    • Ankle: dorsiflexion
    • Positive: radiating leg pain or paresthesia below the knee, typically between about 30° and 70° of hip flexion. Adding ankle dorsiflexion that worsens symptoms supports a neural source.

Sacroiliac

  • Long sitting
    • Patient supine with therapist palpating the medial malleolus- therapist observes alignment. The therapist then asks the patient to come to a long sitting position to observe if alignment at the medial malleolus is still present.
      • Tests for a functional leg length difference caused by sacroiliac/innominate dysfunction
    • Positive: leg length changes between supine and long sitting. Long in supine to short in long sitting indicates anterior innominate rotation; short to long indicates posterior innominate rotation (memory aid: long-to-short = anterior).
  • Gaenslen’s test
    • Patient supine with one leg hanging off the table edge; the therapist presses the opposite flexed knee toward the chest while pressing down through the hanging leg
      • Provocation test for the sacroiliac joint
    • Positive: reproduction of the patient’s familiar pain

Temporomandibular joint (TMJ)

A bilateral synovial joint with articulation between the mandible and the cranium. The articular disc lies between areas of articulation in which there is no vascularization or neural supply. The disc (collateral) ligaments attach the disc to the condyle, so the disc moves anteriorly and posteriorly with the condyle while being kept from displacing medially or laterally. Movements of the TMJ are a combination of axis rotation and sliding movements. Types of movement are seen below:

  • Elevation (closing):
    • Contraction of the masseter, temporalis, and medial pterygoid muscles raises the mandible.
  • Depression (opening):
    • Relaxation of the elevator muscles and contraction of the lateral pterygoid, digastric, geniohyoid, and mylohyoid muscles lowers the mandible.
  • Protrusion (forward movement):
    • Contraction of the lateral pterygoid muscles moves the mandible forward.
  • Retrusion (backward movement):
    • Contraction of the posterior fibers of the temporalis muscles moves the mandible backward.
  • Lateral deviation (side-to-side movement):
    • Contraction of the lateral pterygoid muscle on one side moves the mandible toward the opposite side.

In TMJ disc displacement with reduction, the displaced disc returns to position as the mouth opens and produces a click; in disc displacement without reduction, the disc stays displaced, the click disappears and mouth opening is limited (closed lock).

Special tests of TMJ

  • TMJ compression
    • Patient sitting or supine; therapist stabilizes the patient’s head with one hand while the other hand pushes the mandible superiorly, causing a compressive load to the TMJ
      • Assess pain in the retrodiscal tissues
    • Positive: pain in the TMJ
Key points

PTA role in special tests

  • Perform tests only within existing plan of care to collect data, not to diagnose or alter treatment
  • Report positive findings to supervising PT
  • Stop testing/activity if symptoms peripheralize, worsen sharply, or red flags appear (saddle anesthesia, bowel/bladder changes); document and report

Thoracic spine scoliosis screening

  • Adams forward bend test: child bends forward, knees straight
  • Positive: rib elevation/asymmetry on one side indicates spinal curvature

Lumbar spine special tests

  • Slump test: sequential slump, neck flexion, knee extension, ankle dorsiflexion; positive = reproduction of neural symptoms (pain, paresthesia); symptom relief with neck extension supports a neural (not hamstring) origin
  • Prone instability test: PA springing with feet on floor vs. legs lifted; positive = pain resolves with active leg lift, indicating muscular stabilization capacity (lumbar instability)
  • Lumbar quadrant/Kemp’s test: standing extension + rotation + lateral flexion toward painful side with overpressure; positive = dermatomal pain/paresthesia (nerve compression) or localized pain (facet dysfunction)

Lower limb neural tension tests

  • Prone knee flexion (femoral nerve stretch test): prone, knee flexion + hip extension; positive = anterior thigh pain/paresthesia (L2-L4/femoral nerve)
  • Straight leg raise (SLR): hip flexion, knee extension, ankle dorsiflexion; positive = radiating pain below knee typically between 30°-70° hip flexion; worsening with dorsiflexion supports neural source (sciatic/tibial nerve)

Sacroiliac joint test

  • Supine-to-long-sitting test: compare medial malleoli alignment supine vs. long sitting
  • Positive = leg length change: long→short indicates anterior innominate rotation; short→long indicates posterior rotation (mnemonic: long-to-short = anterior)

TMJ anatomy and movements

  • Bilateral synovial joint (mandible-cranium) with avascular, non-innervated articular disc stabilized by collateral ligaments
  • Movements: elevation (masseter, temporalis, medial pterygoid), depression (lateral pterygoid, digastric, geniohyoid, mylohyoid), protrusion (lateral pterygoid), retrusion (posterior temporalis), lateral deviation (unilateral lateral pterygoid moves mandible to opposite side)

TMJ special test

  • TMJ compression: stabilize head, push mandible superiorly to compress joint/retrodiscal tissue
  • Positive = pain in TMJ

More from Special tests of the spine, pelvis, and temporomandibular joint

  • Cervical spine tests